The objective of an infertility evaluation is to discover why a couple is struggling to get pregnant. An infertility evaluation may be appropriate if you have not become pregnancy after a year of unprotected sexual intercourse. For patients 35 years old and older, evaluation may be appropriate after 6 months of unprotected intercourse without pregnancy. It may also be appropriate to undergo evaluation before 6 months of unprotected intercourse if your periods are irregular.
Office Visit
The evaluation begins with a conversation with a gynecologist. Along with a medical history, questions will include basic questions like medications, medical problems, prior surgeries, and experiences with prior pregnancies. Questions will also cover menstrual history, sexual habits and previous contraception methods. Finally, an exam will be performed which may screen for cancer and infection.
Semen Analysis
Since a third of the cases of infertility are related to male factors, semen analysis is usually recommended. This test will demonstrate that the sperm count is normal and that the sperm are motile. OB/GYN Associates uses the North Mississippi Medical Center laboratory for this test. The clinic can provide a sterile specimen container and orders for the test. The specimen should be collected before presenting to the hospital and kept body temperature. The specimen should not be more than an hour old. The hospital lab prefers to receive the specimen in the morning before 9 AM on Monday through Friday.
Progesterone Level
Progesterone is a byproduct of ovulation and when blood levels are elevated, it is an indication that ovulation has occurred during that cycle. Since ovulation frequently happens between days 11-18, progesterone levels are tested around day 21 after ovulation is likely to have already occurred. If day 21 falls on a weekend, it may be collected the Friday before or Sunday after depending when which is closest to day 21. A low progesterone level may be an indication that ovulation did not occur.
Hysterosalpingogram/Sonohystogram
Imaging studies of the female reproductive tract is helpful to demonstrate normal anatomy and evaluate for blockage of the fallopian tubes. Hysterosalpingogram is an X-ray of the uterus and is performed in combination with dye introduced into the uterus to see if the shape of the interior of the uterus is normal. Usually the dye runs backward through the fallopian tubes to demonstrate that they are open. This test is performed by the radiologist at Women’s Hospital and is scheduled at the end of your period. Alternatively, images may be taken of the uterus and tubes using ultrasound in the office while sterile water is introduced into the uterus. This test, a sonohystogram, is less expense but less reliable in evaluating the fallopian tubes.
Laparoscopy
Although this surgery is not considered as part of the basic infertility evaluation, it is commonly used to evaluate for endometriosis, pelvic scarring and in cases of unexplained infertility. This outpatient surgery involves introducing a small video camera into the abdomen through the belly button while the patient is asleep. This surgery can be used to diagnoses the cause of infertility but is also useful for treating endometriosis, scar tissue or obstructed fallopian tubes at the same time. This surgery serves both a diagnostic purpose but frequently is part of the treatment for female infertility issues.